As a hospice chaplain, Fred Brason II knew how important opioids were for relieving pain at the end of life, but as he consoled family members of overdose victims, he also saw what could happen if these medications weren’t used properly. Brason started a program offering a balanced approach to preventing drug overdoses while ensuring that patients in need of pain management were getting care.
The first challenge was getting the community to admit that there was a problem. “It’s the kind of thing people want to keep under the table,” said Brason, who started Project Lazarus in Wilkes County, N.C., to provide technical assistance and training on overdose prevention. The program also forges coalitions with community groups, clinicians, law enforcement, service providers, and pharmacies to help raise awareness and implement strategies for reducing prescription drug abuse.
When the community suffered three overdose deaths in two days, Brason said, “Everybody woke up.” He now develops overdose prevention programs for the U.S. military, Native Americans, pregnant women, and the North Carolina Community Care Medicaid management system.
For his tireless determination to tackle the problem of prescription drug abuse, Brason has been named one of 10 recipients of the Robert Wood Johnson Foundation Community Health Leaders Award for 2012. The award honors exceptional men and women who have overcome significant obstacles to tackle some of the most challenging health and health care problems facing their communities. Brason will receive the award during a ceremony in San Antonio on October 17.
When Brason began to explore how the community addressed substance abuse, he learned that law enforcement and hospitals knew there was a problem, but like most communities throughout the United States, they were struggling with how to address it. Brason was instrumental in helping to rewrite the local hospital’s pain management policy. He also worked to change the law to make it possible for local phamacies to collect and dispose of unused prescription medications.
“The first thing we had to do was get everybody past the blame game. Everyone was pointing fingers and saying doctors are over-prescribing, or the police need to make more arrests. But prescription drug abuse is not that simple,” said Brason, who quickly realized the need to address the problem from a public health perspective. “How can we change the habits of an individual who is addicted? The only way is to get family members, civic organizations, medical providers, youth groups, schools, law enforcement and faith groups aware of the problem and working together on how to solve it and prevent harm. And that’s what we did.”
Overdose deaths decreased by 69 percent in Wilkes County between 2009 and 2011, from 46.0 per 100,000 to 14.4 per 100,000.
In fact, a policy change that Brason spearheaded in Wilkes County hospitals is being adopted in hospitals across North Carolina. “People were telling us they could go into the ER with an ailment of any kind and walk out with a prescription.”
The ER was an easy portal for those seeking drugs to abuse. So his task force reviewed prescribing policies in the ER and, working with physicians and hospital administrators, designed a policy to limit prescribing controlled substances. When a prescription is warranted, the policy states that ERs will no longer provide a 30-day supply of a controlled substance but rather a limited amount, and then refer the patient to a provider so the patient can be monitored and linked to appropriate care services.
Janice Ford Griffin, national program director of Community Health Leaders, said the selection committee honored Brason for his creativity and commitment. “Brason’s tireless efforts to convene disparate elements of the community on an issue that continues to be rife with controversy, anger, and vast disagreement have culminated in real impact measured in statistics recognized by health professionals, law enforcement, and the community at large,” said Griffin.
On a recent visit to Brason’s program, Gil Kerlikowske, director of the White House Office of National Drug Control Policy, said, “Project Lazarus is an exceptional organization, not only because it saves lives in Wilkes County, but also because it sets a pioneering example in community-based public health for the rest of the country.”
According to Brason, striking the right balance on a solution is critical to success. “If your solution emphasizes law enforcement too much or limits the medical community too much, you create a larger problem trying to fix the problem,” he said. We don’t want doctors to stop seeing patients who do need help. At the same time, we need to tighten the supply so that there is no longer easy access. Most importantly, we must have places for people to get effective substance abuse treatment, or we’re right back at square one.”
Nabarun Dasgupta, an epidemiologist at the Gillings School of Global Public Health at the University of North Carolina, nominated Brason for the award. “Fred started Project Lazarus to take a balanced approach to preventing drug overdoses while ensuring pain patients received care,” Dasgupta said. “One of the most innovative aspects Fred championed has been providing pain patients and drug users with the antidote naloxone so they can reverse overdoses themsevels. Other programs had successfully trained heroin users how to use the antidote, but Project Lazarus is the first time this innovative and compassionate approach was used to prevent prescription overdose deaths. It was groundbreaking when started in 2007, and remains the most comprehensive program of its kind in the nation.”
The Robert Wood Johnson Foundation has honored more than 200 Community Health Leaders since 1993. The work of the nine other 2012 recipients includes culturally appropriate care for Native Alaskan elders; a program to prevent and treat cancer among medically underserved populations in South Carolina’s Low Country region; an initiative to connect refugees to mental health services in Seattle; a free health care clinic for the working poor in Little Rock, Ark.; a breast cancer awareness and treatment program for African immigrants in the Washington, D.C., area; support services for Latino survivors of sexual violence in Philadelphia; a project to promote healthy lifestyles and working conditions for immigrant workers in Los Angeles; an initiative to prevent childhood obesity in Garfield, N.J.; and an outreach program to assist older adults living at home in California’s Sierra Nevada Mountains.
For details on how to submit a nomination, including eligibility requirements and selection criteria, visit www.communityhealthleaders.org.